​Professor’s Sabbatical Work Seeks to End Homelessness

Many people believe the root causes of homelessness are mental illness or drug or alcohol abuse. But the fundamental issue is much more basic, according to Dr. Eric L. Hirsch, Providence College professor of sociology.

“The essential problem is actually market failure — the failure of our housing market to distribute housing to a majority of people in Rhode Island at anything close to an affordable amount,” Hirsch said. “It’s about a lack of housing for people who don’t have high incomes.”

Hirsch leads the government relations committee of the Rhode Island Coalition on Homelessness and maintains the state’s Homeless Management Information System, which tracks how homeless people access services.

In 2011, more than 4,400 people spent at least one night in an emergency shelter or transitional housing. More than 1,000 of those were children. And those numbers do not reflect the families who “double-up” — moving into the homes of family or friends to avoid the shelters — which estimates show may have doubled between 2008 and 2010.

Unaffordable housing

Housing in Rhode Island is too expensive for most state residents, Hirsch said. In the 1980s, the average apartment rented for $161 a month. Now the average rent is $1,200 for a two-bedroom. A generally accepted personal finance rule advises that housing costs should not exceed one-third of one’s household income, which would mean families would have to earn $47,000 in household income to afford an apartment. However, the median household income for renters in Rhode Island is not even $30,000.

Housing for the permanently disabled, who receive $8,000 in government assistance annually, is particularly in demand. For those people, “there are nowhere near enough subsidized apartments of any kind to allow you to find a place to live,” Hirsch said.

The amount of state and federal investments to end homelessness peaked in 2005, and those increased resources led to reductions in homelessness counts from 5,000 to 4,000 people, the professor said. That pattern did not continue through the recession.

“Part of the problem is the economic trends that cause an increase in homelessness also cause a decline in state revenues,” he said, noting that collections of sales, property, and other taxes plummet. “States start cutting exactly at the point where they should be increasing support, because we have more and more homeless people,” Hirsch said.

The long-term vision is to end homelessness completely — “everybody has a stable place to call home,” he said. In the short term, the plan spells out steps to try to end homelessness in the next five to 10 years for veterans, families, and people who have been chronically homeless for more than a decade.

Letting people live in homeless shelters is “absurd,” Hirsch said. “It costs money. It doesn’t save money,” he said. “It’s an extraordinarily expensive way to handle the problem.”

End homelessness and save

The strongest argument for a different approach is the fiscal one. “Chronic homelessness is extraordinarily expensive,” he said.

In addition to costs of shelter nights, the biggest expenses homeless people incur are medical bills. About 40 percent of the homeless receive Medicaid, and by 2014 all homeless will receive it under the Affordable Care Act.

As part of his research, Hirsch cross-referenced his database of chronically homeless people with the state Medicaid database. He discovered that Rhode Island spent more than $9 million in nearly two and a half years to care for the top 67 Medicaid billers who are chronically homeless. Ambulance runs, nights in the hospital, and then eventual discharge to a nursing home all cost a lot.

The state spent more than $59,000 per person during that time period, which is far more than the state paid to care for others in the same interval. Disabled adults required about $25,000, and the average Medicaid recipient bills about $10,000 per year, Hirsch said.

He said Rhode Island needs more “Housing First” programs, which put people directly into homes and then follow up with intense case management. Hirsch serves as evaluator of the three existing programs statewide.

Generally, people stay in apartments at rates of 90 percent when they have that kind of support, Hirsch said.

Research has shown that when people enter Housing First programs, they bill Medicaid at rates two-thirds less than they were billing before. Hirsch is researching this further, tracking people’s Medicaid billing in the years before and after entering these programs.

“If we put these 67 people into housing and provide them a good case manager, we’ll still wind up saving $1 million a year after paying for the program,” he said.

Housing shortage

But there is a shortage of apartments to put people in, and rental subsidies to pay their rents, he said. Public housing authorities don’t make it a priority to put homeless people in their units, for example.

Hirsch said landlords appreciate the programs, because they get guaranteed rent every month, and if they have problems with a tenant, they can contact the case manager rather than attempt eviction procedures.

The programs are intended to have few requirements or barriers, with case managers encouraging people to make positive changes as opposed to requiring them.

Housing families is also a more cost-effective option, because it’s more expensive to staff a family shelter than to put them in an apartment. “Female heads of these families have very low levels of drug and alcohol abuse, very low levels of mental illness,” Hirsch said. “They just cannot afford the apartments.”

In addition, Hirsch said family shelters, particularly those for victims of domestic violence, often bar men or boys over the age of 12 — and there is no other place for a 13-year-old boy to go.